金丽美 孟建标

[摘要] 目的 探讨益生菌联合早期肠内营养对脓毒症患者炎症反应及免疫功能的影响。 方法 将60例脓毒症患者随机分为观察组与对照组，每组各30例。两组采用早期肠内营养治疗，观察组在对照组基础上结合益生菌治疗。比较两组患者治疗前后各种炎症因子及免疫功能各项指标的变化情况。 结果 治疗前两组患者的TNF-α、IL-8、IL-6水平比较，差异无统计学意义（P>0.05）；治疗后两组患者的TNF-α、IL-8、IL-6水平均显著降低（P<0.05），且观察组患者治疗后的TNF-α、IL-8、IL-6水平显著低于对照组，差异有统计学意义（P<0.05）。治疗前两组患者的各项免疫功能指标CD4+、CD8+、CD4+/CD8+水平比较，差异无统计学意义（P>0.05）；治疗后两组CD4+及CD4+/CD8+显著升高（P<0.05），且观察组患者治疗后的CD4+水平、CD4+/CD8+显著高于对照组，差异有统计学意义（P<0.05）。但两组患者的CD8+水平治疗前后组间及组内比较未见明显变化，差异无统计学意义（P>0.05）。 结论 益生菌联合早期肠内营养可以抑制脓毒症患者的炎症反应，提高机体免疫功能。

[关键词] 脓毒症；益生菌；早期肠内营养；炎症因子；免疫功能

[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-9701（2018）30-0010-03

[Abstract] Objective To investigate the effects of probiotics combined with early enteral nutrition on inflammatory response and immune function in the patients with sepsis. Methods A total of 60 patients with sepsis were randomly divided into observation group and control group， with 30 cases in each group. The two groups were treated with early enteral nutrition. The observation group was treated with probiotics on the basis of the control group. The changes of various inflammatory factors and immune function indexes before and after treatment were compared between the two groups. Results There were no statistically significant differences in the levels of TNF-α， IL-8 and IL-6 between the two groups before treatment （P>0.05）； the levels of TNF-α， IL-8 and IL-6 in the two groups of patients were significantly decreased after treatment （P<0.05）， the levels of TNF-α， IL-8 and IL-6 in the observation group were significantly lower than those in the control group after treatment （P<0.05）. There were no statistically significant differences in various immune function indexes such as CD4+， CD8+， CD4+/CD8+ levels between the two groups before treatment （P>0.05）； CD4+ and CD4+/CD8+ in two groups were increased significantly after treatment（P<0.05）， the CD4+ level and CD4+/CD8+ in the observation group after treatment were significantly higher than those in the control group（P<0.05）. However， there was no significant change in the CD8+ level between the two groups and within groups before and after treatment， and the difference was not significant（P>0.05）. Conclusion Probiotics combined with early enteral nutrition can inhibit the inflammatory response of patients with sepsis and improve the immune function of the body.

[Key words] Sepsis； Probiotics； Early enteral nutrition； Inflammatory factors； Immune function

膿毒症是外科常见的急危重症之一，病情重，并发症多，预后较差[1]。且脓毒症为高分解代谢，会导致蛋白质营养不良，使机体出现负氮平衡及低蛋白血症，若不及时进行营养支持，会使机体免疫力下降，并发症增多，病死率增加[2]。研究发现，炎性介质失控性的释放易导致机体组织损伤及免疫异常[3]。积极的营养治疗可以改善其营养状态，促进其生理功能调控与组织的恢复，且维持免疫功能[4]。肠内营养是一种经胃肠道提供代谢需要的营养物质及其他各种营养素的方式，是综合治疗危重症患者的关键，尤其对脓毒症患者。研究表明，对脓毒症患者进行早期营养支持，不但可以提供能量需求，还可以保护其胃肠道黏膜屏障功能的完整性[5]。益……